Rupture of a dermoid cyst in the subarachnoid space: a case report.

Introduction and importance: Intracranial dermoid cysts (IDC) are defined as rare, slow-growing cystic congenital neoplasms. Rupture of an intracranial dermoid cyst occurs rarely and most often spontaneously and results in potentially serious symptoms. Case presentation: A39-year-old female, with mechanical prosthetic heart valve presented with history of headache for 10 months and generalized tonicoclonic seizures. On the admission, the patient had a normal neurological and cranial nerve exam. The authors performed a computed tomography of the brain, The MRI could not be performed because of the presence of the prosthetic valve, revealed rupture of the dermoid cyst in the bilateral subarachnoid spaces. The patient underwent a large temporal craniotomy and the tumour was well exposed and completely removed without incident, the histopathological examination concludes to dermoid cyst, the patient recovered well from surgery. Clinical discussion: Rupture is a very rare phenomenon. there are about 60 cases reported in the literature. the contents of the cyst disseminate into the subarachnoid and ventricular spaces in the event of rupture. A variety of clinical symptoms is usually caused. The mechanism of spontaneous rupture of the dermoid cyst is unclear. Among the proposed mechanisms is a rapid expansion of the cyst. Complete surgical resection of dermoid cysts is the only effective treatment for the prevention of recurrences and/or complications. Conclusion: Rupture of an intracranial dermoid cyst is associated with significant morbidity and mortality, although it remains a rare phenomenon. Surgical excision should be considered as soon as the diagnosis is made in order to prevent more severe intracranial complication.

Pediatric CHANCE fracture treated by lumbar lacing technique: a case report.

This paper presents the case of an 7-year-old girl victim of a road accident. The neurological examination revealed a conscious patient without any sensory or motor deficit and she had intense lumbar pain. The lumbar computed tomography scan found a chance fracture at the level of L3. the patient was operated under general anaesthesia with a sublaminar lacing fixation of L2-L3 similar to the lacing of C1C2 in upper cervical trauma. The follow-up was good The control X-ray was satisfied with a complete reduction and restoration of the lumbar lordosis and the patient was discharged from the hospital on the fifth day following the intervention. this article shows that sublaminar lacing can be as effective as pedicle screw fixation, thus preserving bone growth.

Glioblastoma simulating an arteriovenous malformation: a case report.

Glioblastoma is the most common primary malignant brain tumor in adults. It is enhanced by the abnormal proliferation of central nervous system cells called astrocytes. Microvascular endothelial proliferation is one of the criteria for a histological diagnosis. Hypervascular glioblastoma simulating an arteriovenous malformation is an involuntary manifestation and constitutes a rare entity. Case presentation: The authors report a case of a 44-year-old patient with no history followed. Symptoms began 6 months ago with the gradual onset of headaches without vomiting or seizures associated with a drop in normal visual acuity without neurological deficit. Cerebral imaging including cerebral angiography concluding with a right parieto-occipital cerebral process probably associated with an arteriovenous malformation. Clinical discussion: The management was surgical by biopsy after a right parieto-occipital bone flap concluding in glioblastoma. The patient needs chemotherapy and radiotherapy sessions with good clinical evolution. Conclusion: The coexistence of an arteriovenous malformation and glioblastoma remains an association whose pathophysiology still remains to be explored.

Vertebromedullary hydatidosis: a case report.

The contamination of humans with the larval form of the tapeworm Echinococcus granulosus results in the parasitic disease known as hypatidosis. Even though hydatid disease is widespread in Maghreb nations, bone hydatidosis is still uncommon. Case presentation: This article presents the case of a 12-year-old child with no particular pathological antecedent, who presents a spinal cord compression syndrome evolving gradually for 2 weeks whose objective clinical examination found a 2/5 paraparesis with a sharp pyramidal syndrome and subxiphoid sensory level. Medullary MRI has objectified an aspect of hydatid cysts at the level of D8 D9 and D10 compressing the spinal cord. Clinical discussion: Management was surgical by decompression by laminectomy of stage D8, D9, and D10 under general anesthesia and put on albendazole, the diagnosis was confirmed by histopathological examination, the evolution was marked by a partial recovery of deficit. Conclusions: Clinical symptomatology is vague with a gradually inescapable movement towards spinal or root pressure.

The utility of the CADISS® system in the dissection of epidural fibrosis in revision lumbar spine surgery (A case series).

Spine surgery and spinal fusion surgery are rising. Revision rates following initial surgery are between 8 and 45%. Epidural fibrosis is a common response to spine surgery for most patients and increases complications in revision surgery. Previous research suggests using MESNA (Sodium 2-mercaptoethane sulfonate) in combination with mechanical blunt dissection safely reduces surgical complications. MESNA is a mucolytic agent which selectively cleaves disulphide bonds involved in the adherence and strength of fibrosis, meaning cutting instruments are not needed. The Chemically Assisted DISSection (CADISS®) System is an optimised non-cutting surgical device, consisting of a reconstitution cartridge for MESNA preparation, irrigated surgical instruments, and a footswitch to control MESNA release. This is the first study to investigate the use of the CADISS® System in revision spine surgery. Methods: This was a prospective, open label, observational case study. We enrolled 21 patients for revision spine surgery with the CADISS® System at two Belgium sites. The primary assessment was the number of successful removals of epidural fibrosis without cutting. The amount of MESNA used, total dissection and procedure time were recorded. For secondary criterion, the surgeons assessed global satisfaction, facilitation of dissection, quickness of action, usability, bleeding reduction and visualisation of the cleavage plane using an 11-point Likert scale (0-10). Due to the exploratory nature, no formal statistical analysis was planned. We calculated the percentage and confidence interval of successful procedures, the medians and corresponding interquartile range of the Likert criterion, and the mean (±SD) of the amount of MESNA used, CADISS® dissection time and total procedure time. Results: 24 fibrosis dissections were performed in 19 patients and 23 were successful (95.8%, CI: 78.9%; 99.9%). The mean amount of MESNA used, mean dissection time and procedure time were 16 ml (±4.94), 16.5 min (±16.1) and 86.3 min (±25.1), respectively. No dural tears were reported. The mean global satisfaction score was 9.0 (8.0-9.0). All other Likert criterion had scores of 8.0 or 9.0, excluding quickness of action, which scored 7.0 (6.0-9.0). Conclusions: The CADISS® System in revision spine surgery has potential to effectively reduce dissection complications.

The value of dynamic MRI in cervical spondylotic myelopathy: About 24 cases.

Dynamic magnetic resonance imaging (MRI) of the cervical spine is extremely useful in assessing pathological changes at the spinal cord, vertebrae, discs, ligaments and facet joints. We attempted to document the radiological changes that the cervical spine undergoes during dynamic maneuvers and the effects of Dynamic MRI in management of cervical myelopathy, emphasizing on the changes in treatment protocol effected by the new findings discovered. Our work is based on 24 consecutive patients with cervical spondylotic myelopathy had cervical MR imaging in neutral position, in flexion and extension of the cervical spine between January 2021 and December 2021. The result found the mean age was 57.9 years (range 26-85 years). Among these 24 patients, there were 11 males and 13 females. Total number of levels of compression were 47 and the additional levels of involvement were 17. Additional levels of compression were noted in 12 patients, among these 17 new levels, 7 were in the posterior and 10 in the anterior. The most affected level was C5C6 with 16 cases. All additional levels of compression were noted in extension; Reduction of the cervical canal was observed in 20 patients only in extension. In the bending sequences we have noticed an increase of the canal diameter in 3 patients. The location of the compression is in 15 cases anterior, 2 cases posterior and 5 cases are mixed anterior and posterior Surgery was considered in 17 patients. Anterior procedures were 11 (ACDF/corpectomy and fusion) and Posterior surgeries were 6 (laminoplasty/laminectomy), and. The rest of the patients did not require surgery and was conservatively treated. A change of the signal was found in 3 patients during the acquisition in extension position a. Most studies have shown a reduction of the root canal with an increase of the compression level, which was the case in our study. MRI is a useful tool for diagnosis of CM, it does not give an exact idea as to which is the offending level in a multilevel compression that requires surgery. Even the approach and procedure cannot be decided on a static examination and hence are subject to significant interpractitioner the role of extension MRI in determining cervical compression levels. Thus, dynamic cervical spine MRI should be an important investigation before we decide to write off surgical treatment in patients with cervical myelopathy and cord signal changes without definitive compression on static MRI. Flexion and extension MRI is an important tool for decision making and planning appropriate management in cervical compressive myelopathy.

Obstruction of ventriculoperitoneal shunt by air bubble: A case report.

Complications related to Ventriculoperitoneal shunt placement are common, and multiple. Among them blockage and infection. We report a case of 44 years old man admitted to our hospital after an obstruction of his ventriculo-peritoneal shunt by an air bubble that caused behavioral problems and confusion. The patient was operated twice, the last time the puncture point had to be changed. The follow up was marked by a clear clinical improvement. Shunt malfunction continues to be a common neurosurgical problem in patients with shunted hydrocephalus, often leading to frequent and sometimes lengthy hospital stays. This case illustrates the management of this rare situation causing air bubble shunt obstruction.

Simultaneous frontal and orbital abscess rare complications of otogenic origin: Case report and literature review.

Otogenic frontal abscess is an uncommon location of otogenic abscess of the brain and constitutes less than 5%. And the orbital extension is even more exceptional. An 11-year-old child, presenting with a two-week-long history of an acute otitis badly treated. Admitted for headaches, fever, vomiting and left eyelid swelling. The preoperative CT scan revealed a left frontal epidural abscess associated to a sub-periosteal Abscess. The patient was operated on. A supraorbital incision through the eyebrows allowed the evacuation of the periorbital abscess and the cerebral empyema through a trephine hole. The patient received probabilistic intravenous antibiotic therapy with ceftriaxon, aminoglycoside and metronidazole. Then relay per os. Postoperative recovery was marked by disappearance of headaches at postoperative Day two and the periorbital edema at day six. The patient was discharged home at postoperative week four with oral antibiotic therapy. Three months postoperative months follow-up CT scan revealed a total radiological cleaning. Otogenic frontal abscess associated to orbital Abscess is extremely rare and should be considered in front of ophthalmological signs. The management is multidisciplinary, and the entry point treatment mustn't be forgotten.

A cerebellopontine angle metastatis of a male breast cancer: Case report.

Male breast cancer is rare, less than 1% of men's cancers. The tumors occurring in the cerebellopontine angle remain a rare entity. Features suggestive of metastasis are acute onset, rapid progression of symptoms. We report a case of a 72-year-old man had a mastectomy and an axillary lymph node dissection for a breast cancer 22 years prior to this report. The patient was admitted with deterioration of level of consciousness with intracranial hypertension syndrome. The magnetic resonance imaging showed a cystic lesion in the left cerebellar hemisphere and the prepontine cistern. We proceeded to a large tumor resection. On the follow up, the patient presented a delayed emergence. A CT scan showed a small hematoma at the surgical site and triventricular hydrocephalus for which the patient underwent a ventriculoperitoneal shunt. This is the first described cerebellopontine angle metastasis of a male breast cancer and the first described case of a metastatic triple hormone negative breast cancer to the brain.

Non-Hodgkin's lymphoma revealed by a cerebral vascular stroke: A case report.

Hemorrhagic lesions in CNS lymphoma are extremely rare. We report the case of a 75-year-old patient admitted to the emergency room following a classic hemorrhagic stroke. The CT scan showed a hyperdense tumor-like process with perilesional edema, the diagnosis reinforced by (MRI). The patient underwent macroscopically total surgical excision and the anatomo pathological examination concluded a diffuse non-Hodgkin's B large cell lymphoma. The follow up was marked by a clear clinical improvement. Primary cerebral lymphomas can be polymorphic, so this diagnosis should always be kept in mind during stroke manifestations. This case illustrates the diagnostic difficulty of this rare and poor prognosis condition.

Reversible hearing loss after 3D video-assisted marsupialization of several posterior fossa arachnoid cysts: A case report.

Very few pediatric cases of arachnoid cyst of ponto-cerebellar angle are described in the literature. Only 4 are described with hearing loss. It is a pathology which poses especially a problem of early diagnosis. In this paper we describe the management of a 16-year-old patient with an arachnoid cyst of the cerebellopontine angle with an isolated auditory deficit that was treated surgically. The follow up was marked by a Full recovery of hearing after surgical treatment. Arachnoid cyst of the cerebellopontine angle is rare in the pediatric population. early surgical management help to increase the chances of recovery.

Extra dural hematoma following a high voltage electrocution accident: A case report.

Electrification accidents is a serious pathology due to the passage of an electric current through the body. The clinical manifestation is mainly represented by skin lesions with burners of different degrees however all the tissues of the body can be affected. The cerebral manifestation is a rare entity described in the literature. In this paper, we report the case of a patient with an electrocution accident manifested by an extradural hematoma who has not encountered a similar case described in the literature. We therefore present this case which poses a poorly understood pathophysiological problem.

Cervical spine dislocation on ankylosing spondylitis: A case report.

Treatment of cervical spine fracture in patients with ankylosing spondylitis is difficult. Biomechanical changes related to ossified ankylosing spondylitis spine make cervical spine fractures highly unstable. They cover the entire width of the spine inducing. multidirectional instability and the risk of neurological injuries. Treatment is more difficult that in the nonossified spine. Different treatments have been proposed including anterior stabilization, posterior stabilization, or both. This paper present a case of an 55-year-old man followed for ankylosing spondylitis admitted for fracture dislocation of c5-c6 following a minimal trauma of which it was operated 4 times in order to obtain a satisfactory reduction and stabilization from which we drew the importance of the osteosynthesis by combined way.

Spinal extradural angiolipomas: A case report.

Angiolipoma are benign tumors composed of mature adipocytes ad mixed with abnormal vascular elements. It reportedly accounts for 0.1-0.5% of all spinal axis tumors in adults and is extremely rare in children. This article describes a case of spinal extradural angiolipoma in a 35-year-old man, who presented with paraplegia and sphincter disorders, the MRI showed extradural spinal lesions at the level of T7 to T10, that squeezed the spinal cord. We attained total resection without any further neurological complication. The diagnosis of SEALs initially can be challenging radiologically since they may imitate other spinal lesions. The gold standard treatment modality should always be surgery, however in some cases, total resection can not be done.

Cerebral hydatid cyst during pregnancy: A case report.

This paper presents the case of an 18-year-old woman in the 31st week of pregnancy complaining for 8 months a several episodes of vomiting and headache the neurological examination revealed muscle power was 3/5 on left side. The cerebral MRI revealed an intracranial hydatid cyst. The cyst was surgically removed under general anesthesia and put it on albendazole, the diagnosis has been confirmed by the histopathological examination. The patient gave a healthy baby 1 month later without any incident. No primary focus was found in the lungs, liver, or other organs. Primary cerebral hydatid cyst during pregnancy can be successfully treated by surgical and medical intervention, vomiting in a pregnant woman should be investigated to rule out other differential diagnosis.